I was disappointed by this attempt to rebut my hypothesis.
My hypothesis was not inchoate (OED “confused or incoherent”) as they obviously understood exactly what I wished to suggest – the conventional wisdom might be wrong or at least need some modification and that Carbon dioxide excretion may play a part in weight regulation.1
We agree that the general public and health professionals are bewildered about weight regulation. That is not a reason to stop thinking and restate conventional wisdoms.
We agree that “the majority of people they surveyed believed that that ”fat shed during weight loss was converted to energy rather than excreted as carbon dioxide and water.” That is not a reason to stop thinking and rely upon conventional wisdoms. I recall a paper that made the point that exhaled Carbon Dioxide might be relevant to fat loss.2 Indeed most people seem to assume that weight can be lost purely by energy production “raised metabolic rates” without a net excretion of heavy atoms but this is a conventional wisdom that is only correct in nuclear reactors in which E=mc2.
Of course self –reporting of food intake is notoriously unreliable. But do we condemn as recidivists3 all those whose weigh loss plateaus on a diet? The same paper suggested a metabolic resistance to the maintenance of a reduced body weight. I merely provided a possible mechanism for this.
We agree that “diets only succeed when the age-old advice to eat less and mov...
I was disappointed by this attempt to rebut my hypothesis.
My hypothesis was not inchoate (OED “confused or incoherent”) as they obviously understood exactly what I wished to suggest – the conventional wisdom might be wrong or at least need some modification and that Carbon dioxide excretion may play a part in weight regulation.1
We agree that the general public and health professionals are bewildered about weight regulation. That is not a reason to stop thinking and restate conventional wisdoms.
We agree that “the majority of people they surveyed believed that that ”fat shed during weight loss was converted to energy rather than excreted as carbon dioxide and water.” That is not a reason to stop thinking and rely upon conventional wisdoms. I recall a paper that made the point that exhaled Carbon Dioxide might be relevant to fat loss.2 Indeed most people seem to assume that weight can be lost purely by energy production “raised metabolic rates” without a net excretion of heavy atoms but this is a conventional wisdom that is only correct in nuclear reactors in which E=mc2.
Of course self –reporting of food intake is notoriously unreliable. But do we condemn as recidivists3 all those whose weigh loss plateaus on a diet? The same paper suggested a metabolic resistance to the maintenance of a reduced body weight. I merely provided a possible mechanism for this.
We agree that “diets only succeed when the age-old advice to eat less and move more is followed so that the carbon atoms ingested are outnumbered by those exhaled.” So their point is?
I submitted a hypothesis and, in the spirit of Karl Popper, I would welcome, not further circumstantial evidence in favour of my hypothesis, but a scientific discussion why I was wrong rather than statements of conventional wisdoms. Their letter was not it.
Philip D Welsby
REFERENCES
1. Welsby PD. Why diets fail: a hypothesis for discussion.Postgrad Med J 2017;93:360-363.
2. Meerman R, Brown AJ. When somebody loses weight, where does the fat go? BMJ 2014;349:g7257.
3. Label RL, Rosenbaum M, Hirsch J. Changes in energy expenditure resulting from altered body weight. N Engl J Med1995;332:332-628.
Philip D Welsby 18/7/17
1, Burnbrae,
Edinburgh EH12 8UB
0131 339 8141 Philipwelsby@aol.com
Fake peer review: the many faces
Viroj Wiwanitkit1
1. Honorary Professor, Dr Dy Patil University, Pune Inida
Email: wviroj@yahoo.com
I read the recent publication by Cheung BMY with a great interest [1]. In fact, this problem is not uncommon and can be seen elsewhere.
Reviews that seem overtly positive can be a clue for suspicious fake reviewing. It is the role of the journal editor to select the reviewer and consider the quality of the review. The fake reviewing might be by a non-existent (totally fake) person or a disguised reviewer. Sometimes, it can be a totally biased reviewer who is recommended by the submitting author.
In addition, a similar problem can also be seen in academic presentations, proposal decisions, funding decisions, as well as academic position appointment decisions. In some underdeveloped countries, it is surprising that non-scientific reviewers can act as academic reviewers when academic work is under consideration. This reflects a poor standard and should be considered as an unacceptable misconduct.
conflict of interest
None
References
1. Cheung BMY. Fake peer review - too good to be true. Postgrad Med J. 2017 Jun 7. pii: postgradmedj-2016-134506.
Conflict of Interest
None declared
It was with great pleasure that we read the observational study by Bosner et al [1] which centres on an aspect salient to all medical students: clinical teacher feedback [2][3][4]. A factor highlighted by Lempp et al, found that students were most pleased with teachers who were approachable and provided them with constructive criticism [4].
As undergraduate medical students at the largest centre for healthcare education in Europe [5], we benefit from experiences in varied teaching settings; ranging from one-to-one sessions to class sizes of up to 450 students. Our clinical curriculum places strong emphasis in the primary health care setting - where we have accumulated nearly 300 hours between us in around 40 practices, both in and around London.
Whilst Bosner et al [1] have presented a well-organised and structured study; we challenge some of the intricacies affecting its overall validity and subsequent conclusions, and therefore propose suggestions for improvements. There is an absence of information pertaining to whether the observers (fifth year medical students) were appropriately trained to effectively judge the quality of feedback given by their seniors (clinical teachers). This is then coupled with no mention of any guidelines or reference used as a “benchmark” for this assessment. Both present issues regarding quality assurance - the necessity and impact of which has been highlighted by Lievens [6].
It was with great pleasure that we read the observational study by Bosner et al [1] which centres on an aspect salient to all medical students: clinical teacher feedback [2][3][4]. A factor highlighted by Lempp et al, found that students were most pleased with teachers who were approachable and provided them with constructive criticism [4].
As undergraduate medical students at the largest centre for healthcare education in Europe [5], we benefit from experiences in varied teaching settings; ranging from one-to-one sessions to class sizes of up to 450 students. Our clinical curriculum places strong emphasis in the primary health care setting - where we have accumulated nearly 300 hours between us in around 40 practices, both in and around London.
Whilst Bosner et al [1] have presented a well-organised and structured study; we challenge some of the intricacies affecting its overall validity and subsequent conclusions, and therefore propose suggestions for improvements. There is an absence of information pertaining to whether the observers (fifth year medical students) were appropriately trained to effectively judge the quality of feedback given by their seniors (clinical teachers). This is then coupled with no mention of any guidelines or reference used as a “benchmark” for this assessment. Both present issues regarding quality assurance - the necessity and impact of which has been highlighted by Lievens [6].
The presence of the observers may have biased general practitioner (GP) attitudes towards their respective students, an aspect which is further complicated by the fact that in some instances, none of the students collecting the data were present, but instead a video camera [7]. Furthermore, Bosner et al [1] have not stated what pre-study information was available to the GPs involved as this could similarly influence GP behaviour. In addition, as the project was conducted in only 12 practices and associated with only one university (in Marburg, Germany) there must be a degree of caution with extrapolating the findings to teaching across all GP settings.
Whilst some of the improvements can be interpreted from our suggested limitations, such as evidence of appropriate training and mechanisms in place for quality assurance; we have made additional recommendations after reflecting on our own clinical experiences.
At several points the authors have touched on factors that could help form a vital role in helping understand the reasons behind GP’s verification and feedback, however these have not been developed. For example, Bosner et al [1] differentiates practices as “urban” or “rural,” but have not stated their findings for particular GPs. Walter et al [8] found that students in the rural setting performed better in their exams, and hence this distinction may have been informative. Table 2 lists patients’ reason for attending the clinic, ranging from “health education,” to “acute threatening.” This could similarly influence the time the GPs had for student interaction. It therefore may have been of use to stratify the points from Table 1 and 2 with findings of their respective observation sessions, to allow for any correlations to be drawn. Similar organisation of observation findings between field observed and video camera recording sessions may highlight any potential bias in the GPs behaviour as referred to above.
Finally a further subdivision of the feedback given should have been to categorise whether a constructive element was present. Joyner et al [9] noted constructive feedback as an important feature of medical student learning and development.
In conclusion, we were pleased to read this review and the recommendations for more specific feedback in general practice placements. We agree that such feedback will help undergraduate medical students progress as better clinical practitioners. However, some of the limitations discussed above do impact the use of this study in shaping medical education. Furthermore, identifying the barriers would assist medical educationalists in forming solutions to solve these issues.
References:
1. Bösner, S., Roth, L.M., Duncan, G.F. and Donner-Banzhoff, N., 2017. Verification and feedback for medical students: an observational study during general practice rotations. Postgraduate medical journal, 93(1095), pp.3-7.
2. Ende, J., 1983. Feedback in clinical medical education. Jama, 250(6), pp.777-781.
3. Poulos, A. and Mahony, M.J., 2008. Effectiveness of feedback: The students’ perspective. Assessment & Evaluation in Higher Education, 33(2), pp.143-154.
4. Lempp, H. and Seale, C., 2004. The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching. Bmj, 329(7469), pp.770-773.
5. Website Accessed on 2/2/2017: http://www.kingshealthpartners.org/about-us/our-partnership
6. Lievens, F., 2001. Assessor training strategies and their effects on accuracy, interrater reliability, and discriminant validity. Journal of Applied Psychology, 86(2), p.255.
7. Baker, P.G., Dalton, L. and Walker, J., 2003. Rural general practitioner preceptors–how can effective undergraduate teaching be supported or improved. Rural and Remote Health, 3, p.107.
8. Walters, L., Worley, P., Prideaux, D. and Lange, K., 2008. Do consultations in rural general practice take more time when practitioners are precepting medical students?. Medical education, 42(1), pp.69-73.
9. Joyner, B. and Young, L., 2006. Teaching medical students using role play: twelve tips for successful role plays. Medical teacher, 28(3), pp.225-229.
The correct statement is as follows:
The portion of the stomach within which H. pylori localises has profound
impact on its clinical sequelae. H. pylori colonization of the antrum
results in increased acid production which may lead to duodenal ulcer
formation. On the other hand, infection within the body of the stomach
predisposes individuals to atrophic gastritis, which, in turn, may
progress to precancerous lesions a...
The correct statement is as follows:
The portion of the stomach within which H. pylori localises has profound
impact on its clinical sequelae. H. pylori colonization of the antrum
results in increased acid production which may lead to duodenal ulcer
formation. On the other hand, infection within the body of the stomach
predisposes individuals to atrophic gastritis, which, in turn, may
progress to precancerous lesions and gastric cancer.
The article states:
=======================================================The portion of the
stomach within which H. pylori localises has profound impact on its
clinical sequelae.18 H. pylori infection within the body of the stomach
results in increased acid production and peptic ulcer disease. On the
other hand, infection of the antrum predisposes individuals to atrophic
gastritis, which, in turn, may progress to preca...
The article states:
=======================================================The portion of the
stomach within which H. pylori localises has profound impact on its
clinical sequelae.18 H. pylori infection within the body of the stomach
results in increased acid production and peptic ulcer disease. On the
other hand, infection of the antrum predisposes individuals to atrophic
gastritis, which, in turn, may progress to precancerous lesions and
gastric cancer. =======================================================
The gastric location of the above statements is incorrect and
reversed. Infection of the antrum, not body, results in increase acid
production leading to ulcer disease. Vice-versa, infection of the body,
not antrum, results in atrophic gastritis and may lead to malignancy.
I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.
I would like to share the experience in our country. Singapore is a country in Sout...
I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.
I would like to share the experience in our country. Singapore is a country in South-East Asia. All public hospital junior staff communicate via mobile technology. There are no bleeps. Mobile technology is an essential communication tool. A majority of junior doctors, housemen and medical officer grades are employed by a government-linked company, which gives out monthly mobile phone subscription fee subsidies. Mobile phone numbers of doctors are published on the hospital intranets. As the mobile phones are always with the doctors, each doctor is more easily accessible and can attend to patients in a swifter manner, potentially improving patient care. Consequently, many doctors carry two mobile phones around - a personal phone and a work phone. The same work mobile phone with an internet subscription allows the doctor to access journals, articles and databases literally at his finger tips.
There is potential in mobile technology and I urge interested parties to embrace it.
I read with interest the manuscipt by Jeyaruban and colleagues.
However I am disappointed that a major issue identified was a "Failure of
adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically
relevant impact on gout management.
Surgical weight loss is one of the few non medication related
interventions that has a substantial impact on serum urate.
I read with interest the manuscipt by Jeyaruban and colleagues.
However I am disappointed that a major issue identified was a "Failure of
adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically
relevant impact on gout management.
Surgical weight loss is one of the few non medication related
interventions that has a substantial impact on serum urate.
The American College of Rheumatology recognised this in the 2012 ACR
Gout guidelines by saying "the TFP [Task Force Panel] recognized that diet
and lifestyle measures alone provide therapeutically insufficient serum
urate-lowering effects and/or gout attack prophylaxis for a large fraction
of individuals with gout".
One of the problems with lack of high quality gout care in Australia
in my opinion is the undue emphasis on non-evidence based interventions,
that, even if effective (which they have not shown to be yet), have a
small effect size. This is often to the detriment of emphasis on effective
evidence based therapies (all of which are currently medication based).
A focus on effective evidence based therapies would likely lead to a
better level of gout care by all involved with caring for these patients.
Conflict of Interest:
Menarini and AstraZeneca (Research Funding and Speaking)
We are living a new epoch all over the world. Also in clinical
medicine. As it is known, for example, the model of a single doctor
participating heavily at each step of treatment is giving way to expanded-
care teams.
Moreno-Rodriguez identified an universal crisis of the clinical
method, with dangerous consequences in the practice of medicine. Among its
main causes there are: a deteriora...
We are living a new epoch all over the world. Also in clinical
medicine. As it is known, for example, the model of a single doctor
participating heavily at each step of treatment is giving way to expanded-
care teams.
Moreno-Rodriguez identified an universal crisis of the clinical
method, with dangerous consequences in the practice of medicine. Among its
main causes there are: a deterioration in the doctor-patient relationship,
the undervaluation of clinics, the process of specialization, the
overvaluation of technology, and the indifference for general medicine.
(1)
Moreover, the rigid implementation of guidelines and protocols
adopted as an "standardized new medicine", tend to favor a person "non-
centered" medicine. (2) So, the doctor/patient relationship has been
diluted. These elements are more evident in the elderly patients, usually
with several chronic conditions, when they attend to Emergency
Departments,.
The case referred by John Launer in the Postgraduate Medical Journal
recently is common in the Casualty Departments of great general hospitals.
(3) In order to minimize these situations in our Hospital General
Universitario Dr. Gustavo Aldereguia Lima, daily emergency teams are
carefully planned with enough number of specialists in Internal Medicine,
Emergency Medicine, General Surgery, Traumatology, and the main
specialties of the center, all of them working at the same local of this
service, besides residents and internships. Specialists supervise -joined
with nurses- the continuous care of the patients that stay for abnormal
long periods in this department and in a beside Observation room, and
decide the final output of them: return to the community or admission to
the hospital wards.
No one system is perfect, but the knowledge of this new scenario in
clinical medicine, with the possibility to order different tests -many of
them unnecessary- particularly by the young doctors, (4) and the care
segmentation by different doctors of several specialties, is the first
step to avoid tortuous evolution in this new context.
As a BMJ Editor's choice several years ago expressed: "What is it
that doctors offer that other professionals cannot? Diagnosis, diagnosis,
diagnosis," so for good results the clinical gist in essential, (5)
including the indispensable humanitarianism of our profession.
Professor Alfredo D. Espinosa-Brito, MD, PhD,
Professor Angel J. Romero-Cabrera, MD, PhD,
Professor Alfredo A. Espinosa-Roca, MD, PhD
References:
1. Moreno-Rodriguez MA. Crisis del metodo clinico. Medisur
(Suplemento "El metodo clinico") 2010; 8(5):32-36.
2. Espinosa-Brito A. La medicina centrada en las personas y la medicina
personalizada. Medisur. 2015;13(6):920-924.
3. Launer J. Clinical gist. Postgrad Med J 2016;92:121 -122.
4. Nelson B. Waste: Unnecessary Overuse of Medical Care Causes Both Waste
and Harm. The Hospitalist 2015;19(6):23-27.
5. Editor's choice. Diagnosis, diagnosis, diagnosis. BMJ. 2002;324 (2
March). [accesed 11 Aug 2007]. Available in:
http://dx.doi.org/10.1136/bmj.324.7336.0/ghttp:/ BMJ 2002;324:g
Promoting healthy eating certainly needs to be a greater priority
within the NHS but I suspect changing culture will be easier said than
done.
I the hospital I worked at last year, the central point of the hospital
was a Greggs. There was no canteen and whilst there was a cafe selling
healthier food above the Greggs I found many patients did not know it
existed and for the staff it did not have the same opening hours as...
Promoting healthy eating certainly needs to be a greater priority
within the NHS but I suspect changing culture will be easier said than
done.
I the hospital I worked at last year, the central point of the hospital
was a Greggs. There was no canteen and whilst there was a cafe selling
healthier food above the Greggs I found many patients did not know it
existed and for the staff it did not have the same opening hours as
Greggs. This makes healthy eating in this context the more difficult
option, especially as its location is so central to the hospital, it makes
it hard to ignore. Changing this would involve a massive overhaul in the
structure and culture of the hospital, especially as it is reportedly the
second busiest Greggs in the country(1)
It is not just availability of healthy food in the hospital however than
needs the be made easier, in hospitals where there are limited choices of
food options out of hours, many choose to send relatives or parents to
local shops for food. Frequently the only places open out of hours are
fast food restaurants and take-aways. In fact in another hospital I have
worked at, there was a fish and chip shop opposite the hospital which
boasted 'low calorie oil' and advised people the 'look after their heart'
by eating there. A cross-sectional study in the BMJ last year found that
just living or working in close proximity to fast-food restaurants (2)
I feel it is not just hospitals but a whole cultural shift that needs to
occur to promote healthier eating in this country.
1. Express and Star Aug 4 2014. Available from URL
http://www.expressandstar.com/news/2014/08/04/new-cross-hospitals-greggs-
the-second-busiest-in-country/
2.Associations between exposure to takeaway food outlets, takeaway food
consumption, and body weight in Cambridgeshire, UK: population based,
cross sectional study. BMJ 2014;348:g1464
I was disappointed by this attempt to rebut my hypothesis.
My hypothesis was not inchoate (OED “confused or incoherent”) as they obviously understood exactly what I wished to suggest – the conventional wisdom might be wrong or at least need some modification and that Carbon dioxide excretion may play a part in weight regulation.1
We agree that the general public and health professionals are bewildered about weight regulation. That is not a reason to stop thinking and restate conventional wisdoms.
We agree that “the majority of people they surveyed believed that that ”fat shed during weight loss was converted to energy rather than excreted as carbon dioxide and water.” That is not a reason to stop thinking and rely upon conventional wisdoms. I recall a paper that made the point that exhaled Carbon Dioxide might be relevant to fat loss.2 Indeed most people seem to assume that weight can be lost purely by energy production “raised metabolic rates” without a net excretion of heavy atoms but this is a conventional wisdom that is only correct in nuclear reactors in which E=mc2.
Of course self –reporting of food intake is notoriously unreliable. But do we condemn as recidivists3 all those whose weigh loss plateaus on a diet? The same paper suggested a metabolic resistance to the maintenance of a reduced body weight. I merely provided a possible mechanism for this.
We agree that “diets only succeed when the age-old advice to eat less and mov...
Show MoreFake peer review: the many faces
Viroj Wiwanitkit1
1. Honorary Professor, Dr Dy Patil University, Pune Inida
Email: wviroj@yahoo.com
I read the recent publication by Cheung BMY with a great interest [1]. In fact, this problem is not uncommon and can be seen elsewhere.
Reviews that seem overtly positive can be a clue for suspicious fake reviewing. It is the role of the journal editor to select the reviewer and consider the quality of the review. The fake reviewing might be by a non-existent (totally fake) person or a disguised reviewer. Sometimes, it can be a totally biased reviewer who is recommended by the submitting author.
In addition, a similar problem can also be seen in academic presentations, proposal decisions, funding decisions, as well as academic position appointment decisions. In some underdeveloped countries, it is surprising that non-scientific reviewers can act as academic reviewers when academic work is under consideration. This reflects a poor standard and should be considered as an unacceptable misconduct.
conflict of interest
None
References
1. Cheung BMY. Fake peer review - too good to be true. Postgrad Med J. 2017 Jun 7. pii: postgradmedj-2016-134506.
Conflict of Interest
None declared
Dear Editor,
It was with great pleasure that we read the observational study by Bosner et al [1] which centres on an aspect salient to all medical students: clinical teacher feedback [2][3][4]. A factor highlighted by Lempp et al, found that students were most pleased with teachers who were approachable and provided them with constructive criticism [4].
As undergraduate medical students at the largest centre for healthcare education in Europe [5], we benefit from experiences in varied teaching settings; ranging from one-to-one sessions to class sizes of up to 450 students. Our clinical curriculum places strong emphasis in the primary health care setting - where we have accumulated nearly 300 hours between us in around 40 practices, both in and around London.
Whilst Bosner et al [1] have presented a well-organised and structured study; we challenge some of the intricacies affecting its overall validity and subsequent conclusions, and therefore propose suggestions for improvements. There is an absence of information pertaining to whether the observers (fifth year medical students) were appropriately trained to effectively judge the quality of feedback given by their seniors (clinical teachers). This is then coupled with no mention of any guidelines or reference used as a “benchmark” for this assessment. Both present issues regarding quality assurance - the necessity and impact of which has been highlighted by Lievens [6].
The presence of the ob...
Show MoreThe correct statement is as follows: The portion of the stomach within which H. pylori localises has profound impact on its clinical sequelae. H. pylori colonization of the antrum results in increased acid production which may lead to duodenal ulcer formation. On the other hand, infection within the body of the stomach predisposes individuals to atrophic gastritis, which, in turn, may progress to precancerous lesions a...
The article states: =======================================================The portion of the stomach within which H. pylori localises has profound impact on its clinical sequelae.18 H. pylori infection within the body of the stomach results in increased acid production and peptic ulcer disease. On the other hand, infection of the antrum predisposes individuals to atrophic gastritis, which, in turn, may progress to preca...
Dear Editor,
I read with interest the article titled "Mobile revolution: a requiem for bleeps?" by Martin et al. The authors state that 73% of people feel that traditional bleeps should be replaced with new mobile technologies. The authors also states the favourable attitudes hospital doctors have towards mobile technology.
I would like to share the experience in our country. Singapore is a country in Sout...
Author's Storify: https://storify.com/nephondemand/equal-work-for- unequal-pay-the-gender-reimbursemen
In response to articles:
American Council of Science and Health News: http://acsh.org/news/2016/08/17/medicare-supports-unequal-pay/
Twitter comments: https://twitter.com/Skepticscalpel/status/767785871500251136
Medscape: http://www.medscape.com/viewarticle/867652?src=rss
Co...
I read with interest the manuscipt by Jeyaruban and colleagues. However I am disappointed that a major issue identified was a "Failure of adherence to lifestyle changes".
There is scant evidence that lifestyle changes have any clinically relevant impact on gout management.
Surgical weight loss is one of the few non medication related interventions that has a substantial impact on serum urate.
...Dear Editor:
We are living a new epoch all over the world. Also in clinical medicine. As it is known, for example, the model of a single doctor participating heavily at each step of treatment is giving way to expanded- care teams.
Moreno-Rodriguez identified an universal crisis of the clinical method, with dangerous consequences in the practice of medicine. Among its main causes there are: a deteriora...
Promoting healthy eating certainly needs to be a greater priority within the NHS but I suspect changing culture will be easier said than done. I the hospital I worked at last year, the central point of the hospital was a Greggs. There was no canteen and whilst there was a cafe selling healthier food above the Greggs I found many patients did not know it existed and for the staff it did not have the same opening hours as...
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